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2118: Hodgkin and NonHodgkin Lymphoma (GYM) Potshot DataRegistry Use Only Sequence Number:Date Received:Key Fields CITY Center Number: CITY Recipient ID: Date of HCT for which this form is being completed:
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How to fill out 2118 hodgkin and non-hodgkin
How to fill out 2118 hodgkin and non-hodgkin
01
To fill out form 2118 for Hodgkin and Non-Hodgkin, follow these steps:
02
Begin by entering the patient's personal information such as name, date of birth, and contact details.
03
Provide the medical history of the patient, including any previous diagnoses and treatments received.
04
Describe the symptoms experienced by the patient and the duration of these symptoms.
05
Specify any laboratory tests or diagnostic procedures conducted and include the results.
06
List any medications currently being taken by the patient and their dosage.
07
Provide details of any known allergies or adverse drug reactions.
08
Indicate any other relevant medical conditions the patient may have.
09
If applicable, mention any family history of Hodgkin or Non-Hodgkin lymphoma.
10
Finally, sign and date the form to certify its accuracy.
11
Ensure that all the information provided is accurate and complete before submitting the form.
Who needs 2118 hodgkin and non-hodgkin?
01
Form 2118 for Hodgkin and Non-Hodgkin is typically required by medical professionals, such as doctors, oncologists, and hematologists, who are involved in the diagnosis and treatment of Hodgkin and Non-Hodgkin lymphoma patients.
02
It is also used by healthcare institutions and insurance companies for documentation and record-keeping purposes.
03
Patients who suspect they may have Hodgkin or Non-Hodgkin lymphoma and seek medical evaluation may also need to fill out this form as part of the diagnostic process.
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